Provider Demographics
NPI:1134312838
Name:TAILLEFER, DAVID MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:TAILLEFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 HIGHWAY 92
Mailing Address - Street 2:SUITE E
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6425
Mailing Address - Country:US
Mailing Address - Phone:678-799-6696
Mailing Address - Fax:
Practice Address - Street 1:9820 HIGHWAY 92
Practice Address - Street 2:SUITE E
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6425
Practice Address - Country:US
Practice Address - Phone:678-799-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor